Care of the Newborn

Newborns are one of the most curious and interesting humans you could ever encounter. They continue to become everyone’s joy wherever they go. As their healthcare provider, we are the ones who handled them primarily the moment they were delivered, so it is up to us to give the best primary care to these little angels before we hand them over to their parents.

Assessment for Well-Being

The Apgar scoring is done during the first 1 minute and 5 minutes of life. The heart rate, respiratory rate, muscle tone, reflex irritability, and the color are evaluated in an infant. Apgar score is the baseline for all future observations.

Indicator

0

1

2

A

Activity

Absent

Flexed arms and legs

Active

P

Pulse

Absent

Below 100 bpm

Over 100 bpm

G

Grimace

Floppy

Minimal response to stimulation

Prompt response to stimulation

A

Appearance

Blue; pale

Pink body, blue extremities

Pink

R

Respiration

Absent

Slow & irregular

Vigorous cry

Each parameter can have the highest score of two and the lowest is 0.

The scores of the five parameters are added to determine the status of the infant.

Corinne is experiencing diarrhea after consuming her prescribed antibiotics for the whole week. This is because:

A

The drugs render food indigestible.

B

Gastric flora is disturbed.

C

Fluid is added into the intestine.

D

Normal intestinal bacteria are destroyed.

Question 1 Explanation:

The destruction of normal intestinal flora causes diarrhea. In choice A, a drug that rendered food indigestible could not be given because it would cause severe malnutrition. Choice B is incorrect because there is no gastric flora. Choice C is incorrect because there is no way to add fluid into the intestine.

Question 2

When a client with chronic obstructive pulmonary disease is taking theophylline also receives ciprofloxacin (Cipro), which of the following interaction could occur?

A

Ciprotoxicity

B

Ineffectiveness of ciprofloxacin

C

Theophylline toxicity

D

Ineffective theophylline

Question 2 Explanation:

Theophylline toxicity may occur because the action of theophylline is increased when given with Ciprofloxacin. There is no such thing as ciprotoxicity.

Question 3

The client at highest risk for nephrotoxicity with aminoglycoside use is a:

A

Male with a creatinine of 1.7 and BUN of 52 on a 10-day regimen

B

Female with BUN of 12 and creatinine of 0.8

C

Female with past history of cystitis on 5 days of therapy

D

Male with history of kidney stones on 8 days of therapy

Question 3 Explanation:

Choice B is incorrect because a 24-year-old woman with a normal BUN and creatinine would not be at higher risk than others when given aminoglycosides. Choice C is incorrect because recurrent cystitis on limited-time therapy does not present a high risk for nephrotoxicity. The last choice is incorrect because a history of kidney stones on limited-time therapy does not present a high risk for nephrotoxicity.

Question 4

When assessing clients for evidence of a penicillin allergy, which of the following symptoms may not be considered to be a true hypersensitivity reaction?

A

Wheezing

B

Nausea

C

Urticaria

D

Angioneurotic edema

Question 4 Explanation:

GI disturbances such as nausea are usually caused by direct irritation or overgrowth of gram-positive bacteria or yeasts and are not indicative of a true penicillin allergy.

Question 5

All of the following symptoms are evidence of a superinfection except:

A

White oral plaques

B

Creamy vaginal discharge

C

Skin rash

D

Darkened tongue

Question 5 Explanation:

Skin rashes are indicative of hypersensitivity reactions in clients on penicillin therapy.

Question 6

Which of the following statements is true when educating clients about penicillin therapy?

A

The client must take the medication at evenly spaced intervals.

B

The client may save leftover medication for a future illness.

C

If signs of an allergic reaction, continue the medication and notify physician.

D

Clients taking oral contraceptives must be cautioned to use an alternate form of birth control while being treated with penicillin.

Question 6 Explanation:

Penicillin will reduce the effectiveness of birth control pills.

Question 7

Antonietta is taking antituberculars, the most common adverse effect she may be experiencing is:

A

Red-orange discoloration of urine

B

Hypersensitivity

C

Hepatotoxicity

D

CHF

Question 7 Explanation:

Hepatotoxicity is the most common side effect associated with antitubercular agents. Orange discoloration is a side effect of rifampin but not with antituberculars in general.

Question 8

In treatment of tuberculosis, the therapeutic rationale for combination drug therapy is to:

Changes in visual acuity and color perception are associated with treatment by which of the following agents?

A

INH (isoniazid)

B

PZA (pyrazinamide)

C

ETH (ethambutol)

D

SM (streptomycin)

Question 9 Explanation:

Ethambutol will cause changes in visual acuity and color perception. Remember “E” for ethambutol and eyes. Peripheral neuropathy is a side effect associated with INH. Gout is a side effect associated with pyrazinamide. Ototoxicity may occur with streptomycin.

Question 10

Which of the following groups of antitubercular agents includes first-line agents?

A

INH, PZA, RIF

B

SM, PAS, INH

C

EMB, PAS, INH

D

INH, cycloserine, RIF

Question 10 Explanation:

INH, PZA, and RIF are used as combination first-line agents.

Question 11

Antitubercular therapy may be determined ineffective when:

A

Sputums are negative.

B

Symptoms resolve.

C

Hepatitis results.

D

Drug-resistant bacteria emerge.

Question 11 Explanation:

The emergence of drug-resistant bacteria indicates that antitubercular therapy is ineffective because the drug(s) are no longer ending bacterial multiplication.

Question 12

Fluconazole (Diflucan) can be administered to a client with:

A

Pneumococcal meningitis

B

Oral thrush

C

Cryptococcal meningitis

D

Pneumococcal pneumonia

Question 12 Explanation:

Fluconazole (Diflucan) is a drug given for the treatment of cryptococcal meningitis. A and D are incorrect because pneumococcal meningitis and pneumonia are not caused by fungal infections. Oral thrush is treated with a more mild antifungal, such as nystatin.

Question 13

When administering amphotericin B, which of the following must be used?

A

A brown bag to protect the infusion from the light

B

A diluent of 5% dextrose with no preservatives

C

A diluent of normal saline with alcohol

D

A micron filter of above l μ

Question 13 Explanation:

Amphotericin B must be mixed with a solution with no preservatives. The solution is sensitive to light but does not require the infusion to be covered. A micron filter should not be used; if unavoidable, it must be less than 1 μ.

Question 14

Which of the following nursing diagnoses might occur when administering large parenteral doses of amphotericin B with vancomycin (Vancocin)?

A

Decreased cardiac output

B

Ineffective airway clearance

C

Ineffective breathing pattern

D

Fluid volume excess

Question 14 Explanation:

These two drugs are both nephrotoxic, so this nursing diagnosis may result from renal problems.

Question 15

Arvic, a 16-year-old student, has acquired systemic fungal infection, he should be treated with:

Allow for a patient to become non-contagious after taking for at least 3 days

D

Are all equally effective and free of side effects

Question 17 Explanation:

This choice correctly describes the action of nucleoside analogs.

Question 18

Which of the following true about protease inhibitors?

A

Work better when used alone.

B

Are the same as nucleoside analogs.

C

Affect replication of HIV at different stage than nucleoside analogs.

D

Have a high level of toxicity.

Question 18 Explanation:

Protease inhibitors cleave the viral polyprotein precursors that are essential for the maturation of infectious virus. Nucleosides interfere with replication of HIV by inhibiting reverse transcriptase. Protease inhibitors work best when used in combination with other drugs.

Question 19

The human cells specifically affected by HIV are:

A

Gonadocytes

B

CD4+ T lymphocytes

C

Islet cells

D

Red blood cells

Question 19 Explanation:

HIV directly affects CD4+ T lymphocytes.

Question 20

Which of the following statements is TRUE about monotherapy for treatment of HIV disease?

A

It is the only FDA-approved treatment for HIV disease

B

It is able to effectively destroy all viral particles of HIV

C

It interferes with the replication of HIV virus without causing any side effects

D

It appears to cause rapid resistance.

Question 20 Explanation:

With monotherapy, resistance can emerge within a few months.

Question 21

Which of the following statements is TRUE about combination therapy for treatment of HIV disease?

Which of the following drugs might be given to relieve pain from corneal abrasions?

A

Proparacaine hydrochloride (Alcaine)

B

Timolol maleate (Timoptic)

C

Betaxolol hydrochloride (Betoptic)

D

Levobunolol hydrochloride (Betagan)

Question 23 Explanation:

This is the only drug listed that is an anesthetic eye preparation.

Question 24

Drugs that lower intraocular pressure work by increasing:

A

the flow of aqueous humor through the anterior chamber.

B

fluid volume in the eye’s anterior chamber.

C

pressure in the eye chambers.

D

diameter of the eye chambers.

Question 24 Explanation:

Drugs that lower intraocular pressure increase the flow of aqueous humor through the eye’s anterior chamber.

Question 25

When administering otic preparations, the nurse should observe the tympanic membrane for:

A

erythema.

B

perforation.

C

fluid.

D

all of the above.

Question 25 Explanation:

The nurse should assess all of these parameters when administering otic preparations.

Question 26

Mara Francesca has been diagnosed with scabies. His physician has ordered crotamiton (Eurax). After 1 week of treatment, the client reports that the pruritus has not stopped. You would advise the client to:

A

Stop applying the medication.

B

Continue treatment because pruritus may persist for 4 to 6 weeks.

C

Call the physician.

D

None of the above.

Question 26 Explanation:

Many times pruritus is not relieved for 4 to 6 weeks after therapy has been initiated. It is never appropriate to discontinue medication without a physician’s direction.

Question 27

Jake has psoriasis of the scalp. The physician has ordered Zetar shampoo. You would advise the client to:

Pediculicides are an effective treatment for head lice. Scabicides are used to treat scabies. Antifungals are used to treat fungal infections. Antivirals are used to treat viral infections.

Question 30

Alice is using antiviral creams for her condition. Which of the following is a potential side effect of the medication?

A

Vulvitis

B

Headache

C

Dizziness

D

Staining of the skin

Question 30 Explanation:

Antiviral creams can cause vulvitis when applied to the genitalia to treat genital herpes.

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Pharmacology: Anti-infective Drugs and Topical Agents (30 Items)

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Corinne is experiencing diarrhea after consuming her prescribed antibiotics for the whole week. This is because:

A

The drugs render food indigestible.

B

Gastric flora is disturbed.

C

Fluid is added into the intestine.

D

Normal intestinal bacteria are destroyed.

Question 1 Explanation:

The destruction of normal intestinal flora causes diarrhea. In choice A, a drug that rendered food indigestible could not be given because it would cause severe malnutrition. Choice B is incorrect because there is no gastric flora. Choice C is incorrect because there is no way to add fluid into the intestine.

Question 2

When a client with chronic obstructive pulmonary disease is taking theophylline also receives ciprofloxacin (Cipro), which of the following interaction could occur?

A

Ciprotoxicity

B

Ineffectiveness of ciprofloxacin

C

Theophylline toxicity

D

Ineffective theophylline

Question 2 Explanation:

Theophylline toxicity may occur because the action of theophylline is increased when given with Ciprofloxacin. There is no such thing as ciprotoxicity.

Question 3

The client at highest risk for nephrotoxicity with aminoglycoside use is a:

A

Male with a creatinine of 1.7 and BUN of 52 on a 10-day regimen

B

Female with BUN of 12 and creatinine of 0.8

C

Female with past history of cystitis on 5 days of therapy

D

Male with history of kidney stones on 8 days of therapy

Question 3 Explanation:

Choice B is incorrect because a 24-year-old woman with a normal BUN and creatinine would not be at higher risk than others when given aminoglycosides. Choice C is incorrect because recurrent cystitis on limited-time therapy does not present a high risk for nephrotoxicity. The last choice is incorrect because a history of kidney stones on limited-time therapy does not present a high risk for nephrotoxicity.

Question 4

When assessing clients for evidence of a penicillin allergy, which of the following symptoms may not be considered to be a true hypersensitivity reaction?

A

Wheezing

B

Nausea

C

Urticaria

D

Angioneurotic edema

Question 4 Explanation:

GI disturbances such as nausea are usually caused by direct irritation or overgrowth of gram-positive bacteria or yeasts and are not indicative of a true penicillin allergy.

Question 5

All of the following symptoms are evidence of a superinfection except:

A

White oral plaques

B

Creamy vaginal discharge

C

Skin rash

D

Darkened tongue

Question 5 Explanation:

Skin rashes are indicative of hypersensitivity reactions in clients on penicillin therapy.

Question 6

Which of the following statements is true when educating clients about penicillin therapy?

A

The client must take the medication at evenly spaced intervals.

B

The client may save leftover medication for a future illness.

C

If signs of an allergic reaction, continue the medication and notify physician.

D

Clients taking oral contraceptives must be cautioned to use an alternate form of birth control while being treated with penicillin.

Question 6 Explanation:

Penicillin will reduce the effectiveness of birth control pills.

Question 7

Antonietta is taking antituberculars, the most common adverse effect she may be experiencing is:

A

Red-orange discoloration of urine

B

Hypersensitivity

C

Hepatotoxicity

D

CHF

Question 7 Explanation:

Hepatotoxicity is the most common side effect associated with antitubercular agents. Orange discoloration is a side effect of rifampin but not with antituberculars in general.

Question 8

In treatment of tuberculosis, the therapeutic rationale for combination drug therapy is to:

Changes in visual acuity and color perception are associated with treatment by which of the following agents?

A

INH (isoniazid)

B

PZA (pyrazinamide)

C

ETH (ethambutol)

D

SM (streptomycin)

Question 9 Explanation:

Ethambutol will cause changes in visual acuity and color perception. Remember “E” for ethambutol and eyes. Peripheral neuropathy is a side effect associated with INH. Gout is a side effect associated with pyrazinamide. Ototoxicity may occur with streptomycin.

Question 10

Which of the following groups of antitubercular agents includes first-line agents?

A

INH, PZA, RIF

B

SM, PAS, INH

C

EMB, PAS, INH

D

INH, cycloserine, RIF

Question 10 Explanation:

INH, PZA, and RIF are used as combination first-line agents.

Question 11

Antitubercular therapy may be determined ineffective when:

A

Sputums are negative.

B

Symptoms resolve.

C

Hepatitis results.

D

Drug-resistant bacteria emerge.

Question 11 Explanation:

The emergence of drug-resistant bacteria indicates that antitubercular therapy is ineffective because the drug(s) are no longer ending bacterial multiplication.

Question 12

Fluconazole (Diflucan) can be administered to a client with:

A

Pneumococcal meningitis

B

Oral thrush

C

Cryptococcal meningitis

D

Pneumococcal pneumonia

Question 12 Explanation:

Fluconazole (Diflucan) is a drug given for the treatment of cryptococcal meningitis. A and D are incorrect because pneumococcal meningitis and pneumonia are not caused by fungal infections. Oral thrush is treated with a more mild antifungal, such as nystatin.

Question 13

When administering amphotericin B, which of the following must be used?

A

A brown bag to protect the infusion from the light

B

A diluent of 5% dextrose with no preservatives

C

A diluent of normal saline with alcohol

D

A micron filter of above l μ

Question 13 Explanation:

Amphotericin B must be mixed with a solution with no preservatives. The solution is sensitive to light but does not require the infusion to be covered. A micron filter should not be used; if unavoidable, it must be less than 1 μ.

Question 14

Which of the following nursing diagnoses might occur when administering large parenteral doses of amphotericin B with vancomycin (Vancocin)?

A

Decreased cardiac output

B

Ineffective airway clearance

C

Ineffective breathing pattern

D

Fluid volume excess

Question 14 Explanation:

These two drugs are both nephrotoxic, so this nursing diagnosis may result from renal problems.

Question 15

Arvic, a 16-year-old student, has acquired systemic fungal infection, he should be treated with:

Allow for a patient to become non-contagious after taking for at least 3 days

D

Are all equally effective and free of side effects

Question 17 Explanation:

This choice correctly describes the action of nucleoside analogs.

Question 18

Which of the following true about protease inhibitors?

A

Work better when used alone.

B

Are the same as nucleoside analogs.

C

Affect replication of HIV at different stage than nucleoside analogs.

D

Have a high level of toxicity.

Question 18 Explanation:

Protease inhibitors cleave the viral polyprotein precursors that are essential for the maturation of infectious virus. Nucleosides interfere with replication of HIV by inhibiting reverse transcriptase. Protease inhibitors work best when used in combination with other drugs.

Question 19

The human cells specifically affected by HIV are:

A

Gonadocytes

B

CD4+ T lymphocytes

C

Islet cells

D

Red blood cells

Question 19 Explanation:

HIV directly affects CD4+ T lymphocytes.

Question 20

Which of the following statements is TRUE about monotherapy for treatment of HIV disease?

A

It is the only FDA-approved treatment for HIV disease

B

It is able to effectively destroy all viral particles of HIV

C

It interferes with the replication of HIV virus without causing any side effects

D

It appears to cause rapid resistance.

Question 20 Explanation:

With monotherapy, resistance can emerge within a few months.

Question 21

Which of the following statements is TRUE about combination therapy for treatment of HIV disease?

Which of the following drugs might be given to relieve pain from corneal abrasions?

A

Proparacaine hydrochloride (Alcaine)

B

Timolol maleate (Timoptic)

C

Betaxolol hydrochloride (Betoptic)

D

Levobunolol hydrochloride (Betagan)

Question 23 Explanation:

This is the only drug listed that is an anesthetic eye preparation.

Question 24

Drugs that lower intraocular pressure work by increasing:

A

the flow of aqueous humor through the anterior chamber.

B

fluid volume in the eye’s anterior chamber.

C

pressure in the eye chambers.

D

diameter of the eye chambers.

Question 24 Explanation:

Drugs that lower intraocular pressure increase the flow of aqueous humor through the eye’s anterior chamber.

Question 25

When administering otic preparations, the nurse should observe the tympanic membrane for:

A

erythema.

B

perforation.

C

fluid.

D

all of the above.

Question 25 Explanation:

The nurse should assess all of these parameters when administering otic preparations.

Question 26

Mara Francesca has been diagnosed with scabies. His physician has ordered crotamiton (Eurax). After 1 week of treatment, the client reports that the pruritus has not stopped. You would advise the client to:

A

Stop applying the medication.

B

Continue treatment because pruritus may persist for 4 to 6 weeks.

C

Call the physician.

D

None of the above.

Question 26 Explanation:

Many times pruritus is not relieved for 4 to 6 weeks after therapy has been initiated. It is never appropriate to discontinue medication without a physician’s direction.

Question 27

Jake has psoriasis of the scalp. The physician has ordered Zetar shampoo. You would advise the client to:

B: Bathing the newborn after feeding could lead to vomiting or aspiration.

D: Waiting to be discharged before bathing the newborn is a long time, the vernix caseosa must be gradually removed through gentle bathing.

The care of the newborn starts at the hand of their healthcare providers and must be transitioned properly to their parents for continuity of care. Appropriate education for the parents and immediate family members regarding the dos and don’ts for newborn care should be included in the discharge plan so that when the newborn is already safe at home, there is a guarantee that they are well-cared for by their family members.